Could a New Court Settlement Require Insurance Carriers in California to Cover ABA?

Last week, the United States Court of Appeals for the Ninth Circuit made a landmark decision in a case involving California’s Mental Health Parity Act (AB-88). In the suit, the plaintiff, who suffers from Anorexia Nervosa, one of the serious mental illnesses covered by California’s Parity Law, argued that because her treatment was deemed medically necessary, that it should have been paid for by her insurance carrier regardless of whether or not it was a plan benefit. In the Parity Act, an insurance plan that falls under the scope of the act is required to provide ALL medically necessary care for serious mental illnesses stating,

“Every health care service plan contract issued, amended, or renewed on or after July 1, 2000, that provides hospital, medical, or surgical coverage shall provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses of a person of any age . . . under the same terms and conditions applied to other medical conditions…”

The court, as well as California’s Department of Managed Healthcare, agreed with the plaintiff and ordered her insurance carrier to pay for her treatment.

What does this mean for children with autism in California? For years, insurance companies have used the excuse that Applied Behavior Analysis (ABA) is not a covered benefit as a means to get out of paying for the expensive therapy. Only time will tell, but this decision certainly opens the door to the possibility of a California which does not discriminate against children with autism by refusing to pay for the medically necessary therapy they need and deserve.

You can read the case summary here: http://calaba.org/ppc/NinthCircuitOpinion_CA-MHPA_Harlick-vs-BlueShield.pdf

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